Individualizing treatment decisions. The likelihood of being helped or harmed

Clinical decision making cannot rely on evidence alone. Although significant advances have occurred in the development of high-quality evidence, similar efforts must be made to develop and evaluate tools that can be used at the bedside to individualize treatment decisions and to facilitate the incorporation of our patients' unique values and circumstances into the decision-making process. These tools should express the helpful and harmful effects of treatment, and it must be possible to modify these statements using patients' values. Finally, this process should be accomplished in real time in a busy clinical practice. In this article, the author outlines some of these decision support tools, describes an attempt to meet some of the challenges inherent in the goal of achieving effective shared decision making, and proposes a patient-centered measure of the likelihood of being helped and harmed by an intervention and discusses its derivation and an evaluation of its usefulness.